Thoracic spinal cord tumor presenting with dysautonomic diarrhea.

A patient, presenting with incapacitating diarrhea of 1-month duration, developed orthostatic hypotension and progressive long tract central nervous system signs. No enteric disease was found to account for the diarrhea. An intramedullary midthoracic spinal cord tumor (ependymoma) was found. Diarrhea and hypotension resolved after local cord decompression and irradiation of the tumor. Dysmotility caused by interruption of thoracic sympathetic pathways to the gut was considered responsible for the diarrhea, and altered splanchnic hemodynamics for the hypotension. The regional autonomic neuroanatomy and the known effects of the autonomic nervous system upon bowel function and the splanchnic circulation explain the patient's symptoms.